When the Alabama Supreme Court ruled those who destroy frozen embryos are liable for wrongful death, they essentially fell back on an age-old anti-abortion argument: that a cluster of cells is a person as soon as sperm fertilizes an egg. That means doctors who perform IVF procedures could end up being criminally prosecuted if, say, they disposed of embryos that aren’t viable — those that have no chance of ever developing into a healthy person, or perhaps not even developing once implanted at all. The threat has the potential to shut down clinics that don’t want to face what could end up being a legal nightmare.
“This really does mean that IVF is likely to become completely inaccessible in the state,” Katie O’Connor, director of federal abortion policy at the National Women’s Law Center, told my colleagues. Abortion politics have been intertwined with fertility treatment in the US since before the very first IVF baby was born in the UK in 1978. In a sense, IVF and the anti-abortion movement grew up together.
In the 1970s, as scientists around the world were racing to figure out how to make a viable embryo in a Petri dish, the Roe v. Wade decision had just kicked the anti-abortion movement into high gear. Anti-abortion activists argued that life began when sperm and eggs combined. It didn’t matter whether that conception was in a person or a Petri dish. This turned IVF research into a lightning rod, as Rutgers University historian Margaret Marsh and her sister Wanda Ronner, a gynecologist, chronicle in their book The Pursuit of Parenthood.“In 1979, a year after the birth of the world’s first IVF baby, a coalition of anti-abortion organizations denounced IVF in an ad in the New York Times as a ‘morally abhorrent’ technology, and they successfully thwarted all efforts to allow federal funding for any research using human embryos,” Marsh told me via email.
Fear of political blowback interfered with the US weighing in on IVF. When a federal ethics advisory board eventually issued support for it, some 13,000 people sent in public comment, most of them in opposition. A moratorium on funding research involving embryos remained in effect. And federal funding typically fuels new basic research. That meant that even as scientists in countries like Australia and the UK were making breakthroughs that would eventually help people suffering from infertility start families, in the US the leading scientists who wanted to do IVF research weren’t pursuing it. When it became clear that IVF was too lucrative and important for US clinics not to even try, private funding stepped in to bring it to America. The first US IVF baby was born in 1981 at the teeny, little-known Eastern Virginia Medical School. Anti-abortion activists protested the clinic. But, as Marsh explained it to me, the school was just five years old, so it didn't have an established reputation to lose or an existing stream of federal research dollars at risk.
The market opportunity for IVF was — and is — huge. Today, one in six people are impacted by infertility, according to the World Health Organization. And eventually the market won out over the politics. The number of assisted reproductive technology procedures — including IVF — was 413,776 in 2021, up 78% from 2015, according to the Centers for Disease Control and Prevention. The global fertility market is expected to balloon to $84 billion by 2028, according to market research firm Imarc.
“Over the years, the anti-abortion movement gradually accepted some reproductive technologies, as long as no embryos were destroyed during their use,” Marsh told me. “But the peace it made with the new technologies was always an uneasy peace.”That early dissent from anti-abortion activists had a lasting impact on the way the industry took shape — it is part of why, for so many people, IVF is difficult to access. Several early Congressional attempts to regulate the IVF industry failed, leaving clinics to come up with protocols and procedures on their own. Without any sort of official endorsement for fertility treatment, few states enacted mandates to cover it and insurers in those states felt no pressure to cover the expensive procedure. Still today, most states do not require private insurers to offer fertility benefits. Only 43% of large US employers offered IVF coverage in 2022. IVF is impossible for most people to afford, typically costing upwards of $10,000 per cycle. So market forces mean clinics are largely clustered in wealthier regions where there are more patients who can pay for it. Now political forces stand to put IVF even further out of reach. — Kristen V. Brown